Correlation of University of Texas Cancer Cachexia Staging (UTCCS) with clinical variables of systemic inflammation, nutritional status, and physical function in patients with cancer cachexia.

Abstract

12046 Background: Cancer cachexia is a heterogenous syndrome characterized by ongoing loss of skeletal mass with or without adipose tissue, that is not entirely reversible. University of Texas Cancer Cachexia Staging (UTCCS) is a recently described novel model for staging cachexia using simple clinical parameters such as body mass index (BMI), serum albumin (alb), neutrophil to lymphocyte ratio (NLR) and resting heart rate (RHR). The validity of this model to correlate with functional status, nutrition and overall survival in patients with advanced or metastatic cancer has been assessed in current study. Methods: In a prospective study of newly diagnosed cancer patients with stage III/IV cancers, >5% body weight loss and serum albumin < 3.5g/dL biomarkers of cachexia were identified. UTCCS was developed using 4 clinical variables namely (BMI), (Alb), (NLR) and (RHR) using quartile as cut off. Based on these variable patients were categorized into stage I, stage II or stage III cancer cachexia. Blood biomarkers, dietary assessment and functional status were estimated. Kaplan-Meier survival curves were generated for patients in each stage. Results: Cancer distribution amongst 110 patients included lung cancer (n=50), GI cancers (n=42) and other cancers (n= 18). Cachexia stage distribution in patients was assessed (stage I= 45%, stage II =36% and stage III=18%). Patients with stage III cachexia had statistically significantly lower ECOG performance status (p=0.006), higher inflammatory state as measured by advanced lung cancer inflammation index (p<0.001), lower simplified nutritional appetite questionnaire (SNAQ score) (p=0.01), lower skeletal muscle index (p=0.03) and 30 seconds chair rise time (p<0.001). Median overall survival (OS) for stage I was 12.7 months, stage II 7.1 months and stage III 3.5 months (p=0.047). Conclusions: UTCCS system is a novel way of estimating the severity of cancer cachexia and correlates with inflammatory, dietary and functional parameters expected in patients with increasing severity of cancer cachexia.